Organization
COMMUNITY COUNSELING & EVALUATION SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. TAMMY JANE KING LCSW (CEO)
(920) 728-1125
Entity
Organization
Contact information
Practice address
115 S MAIN ST, JEFFERSON, WI 53549-1631
(920) 728-1125
Mailing address
125 E WOOLCOCK ST, JEFFERSON, WI 53549-1234
(920) 728-1125
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
6752-123
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1851710909
INDIVIDUAL
WI
Enumeration date
11/18/2017
Last updated
11/18/2017
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